Biofilm-mediated infections by multidrug-resistant microbes: a comprehensive exploration and forward perspectives

A biofilm is a collection of microorganisms organized in a matrix of extracellular polymeric material. Biofilms consist of microbial cells that attach to both surfaces and each other, whether they are living or non-living. These microbial biofilms can lead to hospital-acquired infections and are generally detrimental. They possess the ability to resist the human immune system and antibiotics. The National Institute of Health (NIH) states that biofilm formation is associated with 65% of all microbial illnesses and 80% of chronic illnesses. Additionally, non-device-related microbial biofilm infections include conditions like cystic fibrosis, otitis media, infective endocarditis, and chronic inflammatory disorders. This review aims to provide an overview of research on chronic infections caused by microbial biofilms, methods used for biofilm detection, recent approaches to combat biofilms, and future perspectives, including the development of innovative antimicrobial strategies such as antimicrobial peptides, bacteriophages, and agents that disrupt biofilms.

Regulation of overexpressed efflux pump encoding genes by cinnamon oil and trimethoprim to abolish carbapenem-resistant Acinetobacter baumannii clinical strains

Resistance mechanisms are a shelter for Acinetobacter baumannii to adapt to our environment which causes difficulty for the infections to be treated and WHO declares this organism on the top of pathogens priority for new drug development. The most common mechanism that develops drug resistance is the overexpression of the efflux pump, especially Resistance-nodulation-cell division (RND) family, to almost most antibiotics. The study is designed to detect RND efflux pump genes in A. baumannii, and its correlation to multidrug resistance, in particular, the carbapenems resistance Acinetobacter baumannii (CRAB), and using different inhibitors that restore the antibiotic susceptibility of imipenem. Clinical A. baumannii isolates were recovered from different Egyptian hospitals in Intensive care unit (ICU). The expression of genes in two strains was analyzed using RT-PCR before and after inhibitor treatment. About 100 clinical A. baumannii isolates were recovered and identified and recorded as MDR strains with 75% strains resistant to imipenem. adeB, adeC, adeK, and adeJ were detected in thirty- seven the carbapenems resistance Acinetobacter baumannii (CRAB) strains. Cinnamomum verum oil, Trimethoprim, and Omeprazole was promising inhibitor against 90% of the carbapenems resistance Acinetobacter baumannii (CRAB) strains with a 2-6-fold decrease in imipenem MIC. Downregulation of four genes was associated with the addition of those inhibitors to imipenem for two the carbapenems resistance Acinetobacter baumannii (CRAB) (ACN15 and ACN99) strains, and the effect was confirmed in 24 h killing kinetics. Our investigation points to the carbapenems resistance Acinetobacter baumannii (CRAB) strain's prevalence in Egyptian hospitals with the idea to revive the imipenem activity using natural and chemical drugs as inhibitors that possessed high synergistic activity.

Assessment of heavy metal accumulation and health risk in three essential edible weeds grown on wastewater irrigated soil

The main problem facing Egypt recently is the shortage of available water resources. Therefore, farmers resort to use wastewater for irrigation. So, the present work aims to assess the impacts of wastewater irrigation on the productivity of three edible weeds (Cichorium endivia, Sonchus oleraceous and Beta vulgaris) and its effect on the nutritional value of plants and its risk on human health. This study will focus on Shibin Al Kanater region, and the physicochemical characteristics of drainage water, canal water, drainage water-irrigated soils and canal-irrigated soils were estimated. The vegetative and traits of edible weeds were determined including their photosynthetic pigments, organic and inorganic nutrients content, and heavy metals content. The health risk index (HRI) associated with consumption of polluted plants was created using the estimated exposure factor of a crop to the oral reference dosage of the toxic metal. The main results showed that biomass productivity of S. oleraceous, B. vulgaris and C. endivia increased due to drainage water irrigation with increasing percentage as 27.9, 19.6, and 19.1%, respectively. Irrigation with drainage water significantly increased the photosynthetic pigments of edible weeds. Irrigation with drainage water increased carbohydrate content, crude protein, total soluble sugar, and gross energy in all studied weeds. C. endivia, S. oleraceus and B. vulgaris plants irrigated with canal and drainage water could accumulate Fe, Zn, Cu, and Co in their roots. C. endivia, S. oleraceus and B. vulgaris plants irrigated with canal water indicated HRI more than the unit for Mn, Cu, Pb, and Cd. This research advises that regulation be put in place to prohibit irrigation using untreated drainage and to restrict the discharge of industrial, domestic, and agricultural wastewater into irrigation canals.

Deleterious and ethnic-related BRCA1/2 mutations in tissue and blood of Egyptian colorectal cancer patients and its correlation with human papillomavirus

This study aimed to identify BRCA1/2 mutational patterns in the tissue and blood of Egyptian colorectal cancer (CRC) patients and to study the possible correlation of this mutational pattern with Human papillomavirus (HPV) infection. Eighty-two colonoscopic biopsies and forty-six blood samples were collected from Egyptian CRC patients, as well as blood samples of age and sex-matched healthy controls (n = 43) were enrolled. The libraries were performed using Qiaseq Human BRCA1 and BRCA2 targeted DNA panel and sequenced via Ion proton sequencer. Also, the CRC tissues were subjected to conventional PCR targeting the HPV Late 1 (L1) region. Our analysis revealed that the BRCA-DNA damage pathway had been altered in more than 65% of the CRC patients. Comparing tissue and blood samples from CRC patients, 25 somatic mutations were found exclusively in tissue, while 41 germline mutations were found exclusively in blood. Additionally, we identified 23 shared BRCA1/2 pathogenic (PVs) mutations in both blood and tissue samples, with a significantly higher frequency in blood samples compared to tissue samples. The most affected exon in BRCA1 was exon 10, while the most affected exons in BRCA2 were 11, 14, 18, 24, and 27 exons. Notably, we revealed an ethnic-related cluster of polymorphism variants in our population closely related to South Asian and African ethnicities. Novel PVs were identified and submitted to the ClinVar database. HPV was found in 23.8% of the CRC tissues, and 54% of HPV-positive cases had somatic BRCA1/2 PVs. The results of this research point to a possible connection between infection with HPV and BRCA1/2 mutations in the occurrence of colorectal cancer in the Egyptian population, which has a mixed ethnic background. Our data also indicate that liquid biopsy (blood samples) may be more representative than tissue samples for detecting BRCA1/2 mutations. These findings may have implications for cancer screening and the development of personalized, targeted therapies, such as PARP inhibitors, which can effectively target BRCA1/2 mutations.

Optimization of oil yield of Pelargonium graveolens L'Hér using Box-Behnken design in relation to its antimicrobial activity and in silico study

Pelargonium graveolens L'Hér is an important species of genus Pelargonium with an economic value. The unique rose scent of its oil is used in perfume and cosmetic industry. The oil is characterized by the presence of citronellol, geraniol and rose oxide. Fresh aerial parts of P. graveolens at GC-MS analysis of four seasons revealed that autumn constituted the highest yield of the oil. For the first time, optimization of the yield of extracted oil of P. graveolens was performed employing 3-level Box-Behnken design using 3-factors. The GC-MS analysis of the essential oil was performed for the 17-runs. The optimized extraction of the oil was performed employing numerical optimization and studied for antimicrobial, Minimum Inhibitory Concentration (MIC) and biofilm inhibitory activities. The 3 factors followed rank (plant material amount > water volume > NaCl percent in water), in their magnitude of effect on increasing yield of the oil. Increasing the plant material amount increased the yield of the oil by 6-folds compared to NaCl percent in water. The optimized yield of oil (4 ml) was obtained from extraction criteria (150 g of plant, 750 ml of water and 3.585% (26.85 g) of NaCl). Computational docking was performed to overcome the multi-drug resistant Gram-negative bacilli targeting undecaprenyl pyrophosphate synthase (UPPS). The optimized oil exhibited a promising inhibitory activity against Gram-negative bacteria (K. pneumonia and P. aeruginosa) with significant antibiofilm action (P < 0.05). Moreover, it exerted a synergistic effect when combined with various antibiotics (Cefoxitin, Cloxacillin, Oxacillin and Vancomycin) against MRSA clinical strains.

Evaluation of the knowledge, practices, and attitudes of community pharmacists towards adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs): a cross-sectional study

BACKGROUND

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used over-the-counter medications for the treatment of pain, fever, and inflammation. Gastrointestinal problems and renal complications are the most frequently observed adverse effects associated with NSAID usage. Therefore, this study aims to evaluate the levels of knowledge, attitude, and practice regarding the adverse effects of non-prescription NSAIDs among community pharmacists in Egypt.

METHODS

A 4-month cross-sectional survey, including licenced community pharmacists in Egypt, was conducted. The anonymous Google Forms survey was accompanied by a cover letter explaining its purpose. The survey link was sent to 2000 verified community pharmacist email addresses with clear instructions to complete and submit the questionnaire within 3 weeks. Descriptive and inferential statistical analyses were conducted using IBM-SPSS version 26. The means of variables were compared using analysis of variance test. Pearson correlation was employed to assess the level of linear association between the overall knowledge, practice, and attitude scores. P-value ≤ 0.05 was considered statistically significant.

RESULTS

Approximately 80% of community pharmacists in Egypt exhibit moderate-to-good knowledge regarding the adverse effects of NSAIDs. Additionally, 60.6% of them demonstrated a positive attitude and 80.9% showed moderate-to-good practice scores towards preventing such adverse effects. The education level was the only demographic factor with significant effects on the NSAIDs-related knowledge, practice, and attitude scores. Community pharmacists primarily rely on internet sources for knowledge updates. Additionally, there was a significant positive linear correlation between knowledge and attitude (r = 0.384, P < 0.001), knowledge and practice (r = 0.178, P < 0.001), and between attitude and practice (r = 0.311, P < 0.001) among the participants.

CONCLUSION

Community pharmacists have a vital responsibility to perform screenings, assess patient risk elements, and share knowledge to guarantee the appropriate and safe utilisation of NSAIDs. Given that internet sources are presently the most accessible and used sources of information, governmental directions should prioritise the establishment and enhancement of freely accessible drug information sources for community pharmacists. Further research is necessary to assess the effectiveness of counselling and appropriate guidance provided by community pharmacies in promoting safe and proper drug usage.

Knowledge and information sources of potential drug-drug interactions of healthcare professionals among Buraydah Hospitals

BACKGROUND AND OBJECTIVE

Drug-drug interactions (DDI) are known to increase the risk of morbidity and mortality, and adversely affect the patient's quality of life. The study was to assess healthcare professional's (HCP) knowledge of DDIs in general hospitals of Buraydah.

METHODS

A cross-sectional survey using convenience sampling methods was conducted among 135 healthcare professionals in general hospitals of Buraydah between November and December 2016. The study was carried out after approval and permission from the Regional Research Ethics Committee (November 2016). Respondents were asked to classify 15 drug pairs as 'contraindicated', 'could be used with monitoring', or 'no interaction'. A response option of 'not sure' was also provided. Data were collected using a self-administered questionnaire. The descriptive analysis was done using frequency distribution and percentage for demographic data and other responses to questions. Data were collected, tabulated, and analyzed using Statistical Package for Social Sciences (SPSS) software (version 23). Logistic regression analysis was used to assess the independent variables that affect the HCP knowledge, the significant levels were set at p-value < 0.05.

RESULTS

A total of 135 healthcare professionals were included in the study. The percentage of HCPs who correctly classified the drug pairs ranged from 15 (11.1%) for "Allopurinol + Pyrazinamide" to 90 (66.7%) for "acetaminophen with codeine + amoxicillin". The average number of correctly categorized drug pairs was 5. About one-half of the respondents 73 (54.1%) answered correctly. The level of education was found to be an independent predictor of DDI knowledge. The results from the multivariate analysis indicated that a higher potential DDI knowledge level was associated with pharmacists. Pharmacists had 8.27 times higher DDI knowledge tests than nurses, P value = 0.001. Pharmacists 43(31.9%) were the most cited information source.

CONCLUSIONS

The present study revealed that health care professional's DDI knowledge was inadequate. Level of education was significantly associated with healthcare professionals' DDI knowledge. Pharmacists were the most cited DDI information source. Healthcare professionals should update their DDI knowledge through continuing education and should improve their familiarity with DDI information sources. These updated educations help to provide the appropriate therapeutic outcomes.

Antimicrobial and anti-aflatoxigenic activities of nanoemulsions based on Achillea millefolium and Crocus sativus flower extracts as green promising agents for food preservatives

BACKGROUND

Although the mechanism of action of nanoemulsion is still unclear, the modern use of nanoemulsions made from natural extracts as antimicrobial and anti-aflatoxigenic agents represents a potential food preservation and a safety target.

METHODS

Two natural nanoemulsion extracts of Crocus sativus (the saffron flower) and Achillea millefolium (the yarrow flower) were produced in the current study using a low-energy method that included carboxymethylcellulose and Arabic gum. The synthesized nanoemulsion was fully identified by different analytical methods. Detection of the volatile content was completed using GC-MS analysis. The antioxidant potential, and phenolic compounds content were analyzed in the extractions. The synthesized nanoemulsions were screened for their antimicrobial potential in addition to their anti-aflatoxigenic activity.

RESULTS

The droplet size of Saffron flowers was finer (121.64 ± 2.18 nm) than yarrow flowers (151.21 ± 1.12 nm). The Zeta potential measurements of the yarrow flower (-16.31 ± 2.54 mV) and the saffron flower (-18.55 ± 2.31 mV) both showed high stability, along with low PDI values (0.34-0.41). The nanoemulsion of yarrow flower revealed 51 compounds using gas chromatography-mass spectrometry (GCMS), with hexanal (16.25%), β-Pinene (7.41%), β-Myrcene (5.24%), D-Limonene (5.58%) and Caryophyllene (4.38%) being the most prevalent. Additionally, 31 compounds were detected in the saffron nanoemulsion, with D-limonene (4.89%), isophorone (12.29%), 4-oxy isophorone (8.19%), and safranal (44.84%) being the most abundant. Compared to the nanoemulsion of the yarrow flower, the saffron nanoemulsion had good antibacterial and antifungal activity. Saffron nanoemulsion inhibited total fungal growth by 69.64-71.90% in a simulated liquid medium and demonstrated the most significant decrease in aflatoxin production. Infected strawberry fruits coated with nanoemulsion extracts exhibited high antimicrobial activity in the form of saffron flower and yarrow flower extract nanoemulsions, which inhibited and/or controlled the growth of Aspergillus fungi. Due to this inhibition, the lag phase was noticeably prolonged, the cell load decreased, and the stability time increased.

CONCLUSION

This study will contribute to expanding the theoretical research and utilization of nanoemulsions as green protective agents in agricultural and food industries for a promising protection from the invasion of some pathogenic bacteria and fungi.

Modulating the transcriptomic profile of multidrug-resistant Klebsiella pneumoniae biofilm formation by antibiotics in combination with zinc sulfate

BACKGROUND

Klebsiella pneumoniae is a significant healthcare-associated pathogen. We investigated the antimicrobial interaction pattern between zinc sulfate and antibiotics against K. pneumoniae biofilm on the phenotypic and genotypic levels.

METHODS

Determining the minimum biofilm inhibitory concentrations and the transcriptomic profile of K. pneumoniae biofilm formation genes post-treatment were carried out to evaluate the effect on the phenotypic and genotypic levels, respectively.

RESULTS

Zinc enhanced the antibiofilm potentials of cephalosporins, aminoglycosides, and ertapenem, whereas it antagonizes the effectiveness of fluoroquinolones and meropenem on the phenotypic level. On the molecular level, zinc enhanced the anti-biofilm efficacies of cephalosporins (cefotaxime, ceftriaxone, ceftazidime, cefpirome, and cefepime) via down-regulating the expression of biofilm-related genes by 18-, 38-, 5-, 77- and 2-folds, respectively. Zinc in combination with aminoglycosides (kanamycin, gentamicin, and amikacin) reduced the expression of biofilm-related genes by 40-, 2602- and 20-folds, respectively, and by 2-folds in combination with ertapenem. However, a reduction in the down-regulatory potentials of fluoroquinolones was recorded following combination with zinc by 2-, 2-, 15- and 14-folds, respectively, and an up-regulation in the expression levels of the tested genes by 2-folds in the case of zinc/meropenem combination.

CONCLUSIONS

Results revealed variable interaction patterns between different antibiotics in combination with zinc. Current findings also shed light on the antibiofilm potentials of zinc/antibiotics combinations especially when combining zinc with fluoroquinolones or meropenem to avoid their antagonistic effects.